Lecture 22: Human Genitalia

Question 1

Male and Female Peritoneum and Pouches

Answer 1

Males: 1x peritoneal pouches
1. Vesicorectal pouch: shallow, potential site for fluid to collect
Females: 2x peritoneal pouches
1. Vesicouterine pouch (anterior)
2. Pouch of Douglas/ Rectouterine pouch: deeps, extends to back of uterus–> until where vagina meets cervix. Fluid can pool –> spontaneously drain into vagina (or vagina drain into Pouch of Douglas)

Question 2

State of Peritoneum in pelvic cavity

Answer 2

Peritoneum:

• continuous in the pelvic cavity
• located ontop of pelvic viscera
• -> allows pouches to be created

Question 3

Clinical relevance of Pouch of Douglas re fluid collecting

Answer 3

Pouch of Douglas/Rectouterine pouch is deep –> extends right behind uterus –> until where the vagina reaches the cervix
Therefore if fluid collects here (in this peritoneal pouch) –> risk of spontaneous leakage into vagina (and vice versa)

Question 4

Clinical relevance of Pouch of Douglas re Surgery to remove abdominal tumour/infection

Answer 4

Abdominal Tumour infection
- Dont want abdominal scar from Colicysectomy –> access abdominal cavity re Pouch of Douglas/Rectouterine pouch –> Remove gallbladder

Question 5

Perineal Musculature

Answer 5

1. Ischiocavernosa:
   - attached to Ishiopubic rami + Partially to pubic symphysis
   - Males: Aids erections. Females: Tenses Vagina
2. Bulbospongiosum:
   - attached to Perineal body

Question 6

Male Bulbospongiosum Structure and function

Answer 6

Forms Penis therefore –> combines/attaches at Midline Raphe –> forms Singular muscle
Function:
1. Erection
2. Ejaculation
3. Increases pressure in horizontal part of urethra –> aids Micturition (urination)

Question 7

Female Bulbospongiosum Structure and Function

Answer 7

Forms Labia of Vagina –> Split either side of the vaginal orifice
Function:
1. Clitoral erection
2. Feelings of orgasm

Question 8

Female Erectile Tissue

Answer 8

Located Posterior to Perineal Musculature and follows similar pattern

1. Crus of clitoris: (body of clitoris)
   - attaches onto ischial pubic ramus + perineal membrane
   - sweeps up to pubic symphysis –> detaches to form body of clitoris
2. Bulb of vestibule: a) Head clitoris b) surrounds vaginal orifice

Question 9

Male Erectile Tissue

Answer 9

Located Posterior to Perineal Musculature. Follows similar pattern
Both Crus and Bulb Transfer names as go from urogenital triangle –> form penile structures
- as in males, erectile tissue detaches to become something else
1. Crus of Penis –> once detached/dorsal become Corpus cavernosa of penis (2x)
2. Bulb of penis –> becomes 1x Corpus Spongiosum + Glans Penis (which contains spongy urethra)

Question 10

Vasculature of the Penis

Answer 10

2x Dorsal arteries + 2x Dorsal nerves of penis
1x Deep dorsal vein (b/w ^)
2x Deep (cavernous) artery
Note: Dorsal arteries, nerves + Deep dorsal veins = Below deep fascia of penis
Note: Deep cavernous artery inside Corpus cavernosa
vs Urethra inside Corpus spongiosum
Note: (3x) Superficial dorsal veins of penis = under superficial fascia
Note: ALL arteries/veins in penis = branches of Internal pudendal

Question 11

Gender differences b/w vasculature of the penis

Answer 11

Females have the same, but all are smaller (have shorter courses)

Question 12

How does the Deep dorsal vein of the penis (located b/w dorsal arteries) enter the penis?

Answer 12

Via deficit in peroneal membrane –> vesicular plexus around prostate and bladder

Question 13

Scrotum

Answer 13

Inguinal canal/spermatic cord –> continues into the scrotum of the testes –> creates an outpouching of the skin of the abdominal wall
Scrotum = formed as testes leave the body
Therefore: inner layers of scrotum = same as spermatic cord
Blood supply: branches of Internal (& External) Pudendal arteries

Question 14

Contents of the scrotum

Answer 14

Lower end of spermatic cord
Epididymis
Testes

Question 15

Fascial changes in the scrotum

Answer 15

Abdominal Superficial Scarpa's fascia --> continuous with Superficial testicular fascia --> fat replaced by smooth muscle --> Dartos fascia
Dartos fascia (smooth muscular superficial fascia) --> continues posteriorly with Colle fascia (deep fascia of perineum)

Question 16

Function of Cremaster muscle

Answer 16

Raise testes and scrotum.
Aiding:
1. Warmth
2. Protection

Question 17

Embryonic formation of the scrotum

Answer 17

Mesenchymal cells condense –> form gubernaculum (still undifferentiated tissue) in inguinal canal –> continue into labio-scrotal swelling –> scrotum remains bound by gubernaculum
At end: Scrotum severes of its connection with the peritoneal cavity –> amkes it harder for structures to herniate through

Question 18

Gubernaculum in Males and Females

Answer 18

Males: testes descend through inguinal canal at 7-8 months –> through gubernaculum path –> have same covering as inguinal canal
Females: Uterus is stuck to gubernaculum –> allows ovaries to remain stuck to pelvis.
In females ROUDN LIGAMENT –> goes through inguinal canal

Question 19

Spermatic Cord contents Review

Answer 19

1. Vas Deferens
2. Testicular artery: L2 aortic brach supplies –> Testes and Epididymis
3. Testicular Veins: Pampiniform plexus:
   Right Testicular vein drains to –> IVC
   Left Testicular vein drains to –> L renal vein
4. Lymph vessels: (travels with arteries) Para-aortic nodes at root of testicular artery L2
5. Autonomic Nerves: Sympathetic artery from testicular plexus

Question 20

Origins of additional arteries in Spermatic cord

Answer 20

Arteries:
Inferior epigastric –> Cremasteric artery
Inferior vesical –> Artery of Vas Deferens
Nerves:
Genital branch of Genitofemoral nerve –> innervates cremaster muscle and skin of scrotum

Question 21

Testes

Answer 21

Create sperm (spermatogenesis)
Tunia Albuiginea: Tough outer fibrous capsule
Made up of Lobules --> each lobule contains 1-2 Seminiferous Tubules --> open into Rete Testis --> Efferent Tubules --> Epididymis(sperm storage) --> Vas deferens

Question 22

Temperature of testes

Answer 22

3 degree cooler < abdomen
Cooling is aided by:
1. Dartos fascia (abd. Scarpa fascia fat replaced with muscle –> decreased insulation)
2. Cremaster muscle (allows testes to hang outside)
3. Heat exchange b/w artery and veins

Question 23

Male Internal Genitalia attaching onto epidiymis

Answer 23

Vas deferens –> Ampulla(sperm) –+seminal vesicles (liquid) –> Ejaculatory duct –+urethra–> Prostatic urethra

Question 24

Vas deferens

Answer 24

Muscular tube
Inside spermatic cord –> therefore Travels within Inguinal canal
Note: there is a vas deferens equivalent in females

Question 25

Vas Deferen's course to the prostate

Answer 25

(DIR) Starts LATERAL to Inferior Epigastric artery --> Runs SUPERIORLY to External iliac vessels (passing medially towards prostate) --> Vas deferens runs SUPERIORLY to ureter(urine) --> Joins seminal vesicles --> forms ejaculatory duct which enters prostate

Question 26

Seminal vesicles

Answer 26

Coiled:5cm long --> Uncoiled 10-15cm Secrete Liquid component of ejaculate (fluid + fructose) Note: Fructose = sugar = energy for sperm to make journey to egg Seminal vesicle location: Posterior to bladder, Superior to prostate

Question 27

What are the main components of the prostate gland(s)?

Answer 27

1. Ejaculatory duct | 2. Prostatic urethra

Question 28

Prostate gland

Answer 28

``` Inferior to bladder Ejaculatory duct + prostatic urethra Contains: 1. Proteolytic enzymes 2. Acid phosphotase All arteries supplying are branches of Internal Illiac artery: 1. Internal pudendal 2. Middle rectal 3. Inferior vesicle Veins of prostate gland: Deep dorsal vein of penis --> vesicular plexus (good blood supply)--> Internal Illiac ```

Question 29

Prostatic ligaments

Answer 29

Levator Prostate: "levator" = levitate = lift Located inferior to prostate but anterior to urogenital diaphragm Function: support prostate

Question 30

Prostatic enlargement

Answer 30

Enlargement can be: - All or partial - Benign or malignant Seen commonly in DR as Benign enlargement in 50+ yr old males Outcomes: 1. Postatic enlargement (esp of median lobe) --> Herniation superiorly through sphincter from bladder -->bladder's internal sphincter vesicae unable to close properly --> urinary incontinence 2. Pocket created posteriorly in bladder near sphincter --> pool with fluid --> consistent pressure on sphincter --> continuous feeling of needing to pee

Question 31

How do you Ultrasound a prostate?

Answer 31

Need to have a full bladder | - Prostate is directly inferior to bladder --> therefore need to point US directly down

Question 32

Lymphatic Drainage of male Reproductive system

Answer 32

Testes: para-arotic nodes at root of testicular artery L2 (abdominal > not iliac) Vas Deferens: External Iliac nodes Spermatic Vesicles: External and Internal Iliac nodes Prostate: Internal Iliac nodes Body of Penis/Corpus Cavernosa: Internal Iliac nodes Glans Penis: Deep Inguinal and Iliac nodes (as is superficial) Skin of Penis + Wall of Scrotum: Superficial inguinal - tracts with veins (recess)

Question 33

Components of the Uterus

Answer 33

Vagina --> Fornix --> Cervix --> Body (endo + meso) of Uterus --> Fundus --> Isthmus --> Ampulla --> Infundibulum --> Fimbrae --> Ovaries - ovaries arent connected to the uterine tube --> connected via Broad ligament part of uterine perotineum which sweeps overtop of the utersus - fimbrae create current to encourage egg into uterine tube --> ectopic pregnancy - vagina: muscular tube

Question 34

Fornix

Answer 34

Recess created where vagina and cervix meet | - can access abdominal cavity

Question 35

Creations due to Peritoneum of Uterus

Answer 35

1. Pouches (2x) 2. Broad Ligament (sweeps ontop, and holds ovaries externally onto uterus) 3. Uterine Angulation: a) Bladder is inferior Supporting Uterus --> keeping it angulated and elevated --> Anteflexion --> b) Cervix --> inferior portion of uterus in direction with vagina --> Anteversion

Question 36

Components of Broad Ligament of Uterus

Answer 36

- broad ligament runs through inguinal canal - pulls uterus forward --> ontop of bladder 1. MesoVARIUM (section of broad ligament over ovary) --> a) Suspensory ligament (b/w pelvis + ovary) b) Ovarian ligament (b/w ovary + ligament) 2. MesoSALPHINX (section of broad ligament over uterine tube) 3. Round Ligament 4. MesoMETRIUM (over body) --> Double layer folded over itself

Question 37

Sagital section of Broad ligament diagram

Answer 37

*****

Question 38

Functions of Uterine Ligaments

Answer 38

Ligaments attached to Uterus: 1. Broad Ligaments: carries vessels, nerves + lymphatics (SI support) 2. Round ligament: Creates pot. Lymphatic pathway (superficial inguinal nodes). Anteversion to inguinal nodes Ligaments attached to Cervix: 3. Sacrocervical --> AP support 4. Transverse cervical --> ML support 5. Pubocervical --> AP support

Question 39

What is the uterus supported by

Answer 39

1. Bladder | 2. Ligaments

Question 40

Overview of ovaries

Answer 40

Function: 1. Ova production 2. Hormone production (Oestrogen and Progesterone) --> creates follicular cells Arterial supply: Ovarian artery (abd. aorta L2) Venous drainage: Ovarian venous (IVC on right + Left renal vein on Left) Nerve: Ovarian Plexus

Question 41

External Female genitalia

Answer 41

1. Clitoris (erectile tissue. female version of male penis) --> extremely/most sensitive (contains 8000 nerve endings > male penis less sensitive 2. Vestibule ( enclosed by Labia majora.) Contains: a) opening of urethra b) Greater Vestibular glands (produce mucus) 3. Urethral Orifice 4. Vaginal orifice

Question 42

Female Repro Lymphatic drainage

Answer 42

Ovary + fallopian tube + fundus: Ovarian nodes at root of artery L2 Round ligament: Superficial inguinal nodes Body of uterus/Broad ligament: External Iliac nodes Cervix: Internal Iliac nodes (some sacral) Vagina: 1. Internal Iliac nodes 2. Superficial Inguinal nodes (pathway created via round ligament) Gonads: para-aortic L2

Question 43

Bartholin's Glands

Answer 43

Greater Vestibular glands --> located in vaginal vestibule --> secrete mucus - located posterior + Lateral to vagina - Females version of Bulbourethral glands but in SUPERFICIAL pouch

Question 44

Clinical relevance of Bartholin's Glands

Answer 44

Bartolin's Cyst a) Bartholin glands --> blockage --> inflammation --> CYST b) Cyst --+ (not STD) bacteria --> infection --> ABCESS Treatment depends on severity --> cysts and abcess usually requires drainage